Provider Demographics
NPI:1730272154
Name:BRAZINSKI, MARTIN D (DC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:BRAZINSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4926
Mailing Address - Country:US
Mailing Address - Phone:607-757-0404
Mailing Address - Fax:607-330-1517
Practice Address - Street 1:412 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4926
Practice Address - Country:US
Practice Address - Phone:607-330-2873
Practice Address - Fax:607-330-1517
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0078Medicare ID - Type UnspecifiedCHIROPRACTOR